Obstetrical tractor.



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(Application led Nov. 29, 1901.)

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OBSTETBICAL TRACTOR.

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(Application ma Neige, 1901.) y y No Model.) 4 6 Sheets-Sheet 4.

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E. n. sT. CYR.

OBSTETRICAL TBACTDR.

(Applicatio led Nov. 29, 1901.)

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E. D. ST. CYR.

UBSTETRICAL TRACTOR.

(Application led Nov. 29, 1901.)

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THE Ncnms PErEns co, PHOTO-urne., wnsnnun'on4 o, c.

UNITED STATES ATENT OFFICE.

EMILIEN D. ST. CYR, OF CHICAGO, ILLINOIS.

OBSTETRICALTRACTOR.

SPECIFICATION forming part of Letters Patent 110.713,16, dated November11, 1902.

Application led November 29, 1901. Serial No. 83,952. (No model.)

.To @ZZ whom it may concern:

Be it known that I, EMILIEN D. ST. CYR, a citizen of the United States,residing at Chicago, in the county of Cook and State of Illinois, haveinvented a new and useful Obstetrical Tractor, of which the followin gisa specication.

My invention relates to female surgery; and the object of myimprovementis an obstetrical tractor for the delivery of women in childbirth whichhas all the advantages of the strongest obstetrical forceps with none oftheir disadvantages and which has the further advantage of preparing theway of the infantlodged in the maternal avenue by molding the head toconform to the passage and of opening the passage and at the same timeprotecting the perineum from rupture. I attain these objects by thedevice illustrated in the accompanying drawings, in which- Figure 1 is aplan view of my instrument complete as in the iirst position and withthe cloth fabric in the pockets. The blades are shown locked preparatoryto insertion. The outer surface of the left-hand blade is broken away todisclose a lock for the second position. Fig. 2 is a side view of thesame, showing the curve of the blades and the cord-bordered net andfabric. y Fig. 3 is a plan of the reverse side of the instrument shownat Fig. 1 in the position it assumes after the circumvolution of theblades, the net being paid out and in a full or bag-like condition andits forward margin constricted. Fig. 4 is a plan of the blades in theirposition as in Fig. 3 and with the top or cover of the blades removed toexpose the interior. Fig. 5 is an end view of the handle shown in Fig.l. Figs. 6 and 7 are sections of the same. Fig. 8 is an end view of theforward end of the same blades looking toward the handle and showing theend lock used in the first position. Fig. 9 is a section on the line 9 9of Fig. 3. Fig. 10 is an additional clamp which may be used inreinforcing the lock in the second position. Figs. 11 and 12 show theblades formed without the pocket for the net and adapted for anotherform of handle, and Fig. 13 is a section on the line 13 13 of Fig. 11 asthe same would be if the corded net were inserted. Fig. 14 is a sectionon the line 14 14 of Fig. 12. Figs. 15 to 25, inclusive, representshapes of the cloth form, while Figs. 26, 27, and 28 illustrate theapplication of my device. Figs. 29 to 41, inclusive, illustrate anotherform of my blades or applicators in which the pocket for the net isomitted and the slot is on the top of the blades. Figs. 29 and 30represent the male and female sections of said other forms of bladeswith locks for the second position.

Fig. 31 is a broken plan of the same, taken on the concave side, showingthe slot G eX- tended to the end of the blades or needles. Fig. 32 is aview of the thickened portion of the blades, taken on the reverse sidefrom the view Fig. 31. Fig. 33 is ar View of part of the end of theblades, taken on the reverse side from that shown by Fig. 31. It showsthe opening of the eyes F F. Fig. 34 is a section on line 34 34 of Fig.3l. Fig. 35 is a section through both blades at 35 35 on Figs. 29 and30, showing a lockmnand theeye or canal F. Figs. 36 and 40 are portionsshowing the jointed handle for use in the high operation. Figs. 37 and38 are broken portions of the handle, showing a lock for the rstposition when taken by this form ofthe blades. Fig. 39 shows a portionof the handle of this form of applicator, with a margin of one brokenaway to expose the lock. Fig. 41 shows another form of supplemental endlock to be used with the form in Figs. 29 and 30, in which the parts fuft2 take the place of fc4 and c3 of said figures. Fig.41 alsoillustrates the slight separation by springing a part of the handlesnecessary to unlock the instrument. Fig. 42 is a side elevation of theinstrument shown at Fig. 31 and shows the net when not carried in apocket. Fig. 43 is a front plan, and Fig. 44 a rear plan, of the same,both with the net omitted. Fig. 45 is a section on the line 45 45 ofFig. 44. Fig. 46 is a section on the line 46 46 of Fig. 44, and Fig. 47is a section on line 47 47 of Fig. 44.

Similar letters refer to similar parts throughout the several views.

I have called this instrument, which I have used with success, anobstetrical tractor. It is composed of a net (silk or cotton or otherfabric) and two blades somewhat of the shape of those of the saidforceps,containing in their n interior the loose border of the silk netin such a fashion that by making the circuit of the head with theseblades the head is caught IOO in the net, the blades are locked, andtraction is exerted on the net and not on the blades, as is the casewith the obstetrical forceps, as well as the cause of their dangerouseffects. The pressure is thereby diffused over the whole surface of thehead and renders injury impossible, as will soon be seen,althou ghconserving the possibility of exerting the force of traction to anydegree which the case may demand. To explain the principle clearly, Iwill state the following fact, unnoticed by most of us, but occurringdaily: We have all experienced the difficulty of taking off the sleeveof a tightly-iitting and tightly woven or knitted undergarment whenpulling from the cuff and have felt at that moment that our arm wasbeing dislocated, but that the pressure exerted by the contracted fabricupon the arm was not painful at the point of traction, but only at thesocket of the arm, if long continued. The reason is simply that thepressure is widely and equally diffused, while the traction isconcentrated at one point. The principle employed in this instrumentsuggests this: a strong silk cable is by my device attached to the headof the child, its method of attachment being so diffused as to permit usto use any amount of traction which the case may require Without anypossibility of injury to the mother or the child.

I can now best illustrate the instrument and give the raison dtre of itsdifferent parts by referring to differently-marked parts of the drawingsof the instru mentitself and eX- plaining their use.

The instrument is very simple and uncomplicated. To obtain the easy andproper application of the net over the presenting head, to have itproperly secured and under control and be able to take away the bladesat the will of the operator are the problems to be solved and which areexecuted by this instrument.

The net.The net or fabric C may be made from a girls or misss stockingof ordinary size (cotton or silk) or other preferably contractible anddilatable fabric. The foot is cut off, the leg'is slitted its wholelength, and a strong non-elastic tape or cord (silk or cotton) is fixedat its upper end, the ends of the cord being preferably free. That isall-a tencent stocking and a piece of strong tape or cord. The whole isprepared and treated like our surgical antiseptic gauze dressing.

In the instrument A the metal or rigid portion is composed of two bladesB B', each having an operating extremity b, a shaft b', and a handle b2.

Each operating extremity has the cephalic curve of the ordinaryobstetrical forceps, and they are six and one-half inches in length.They are provided with an internal cavity e e for the purpose ofreceiving each one-half of the upper extremity of the net, allowing itthus to unfold from its center during the application. A groove orlongitudinal canal or eye F in each carrying needle or blade is for thepurpose of receiving the thickened border or cord of the net. Itcommunicates with cavities e e by a very narrow slit G, making it thuspossible to remove both blades from the net and vagina at the will ofthe operator. The small bulbous lobe f is for the purpose ot' lockingthe blades together when it is sunk into socket g. By thus consolidatingboth blades together their introduction is made easy. The small bulbouslobe H, when sunk into socket H', is for the purpose of locking theinstrument after the complete circuit of the head has been accomplishedby the blade, thus securing the strong union of the net at the sacralcurve J. Both these locks are supplemented by the slide I, moving in thedovetail groove @'12, which when passed over the ends of both handles,as in Fig. 5, locks them from moving endwise. Openings 7c 7c of the eyeare for the exit of the cord or tape of the net. The shafts b b are madestrong and have the proper curve to render as'easy as possible thecircumvolution of the operating blade extremities B B around the head.They each form one piece with each operating extremity. The shafts maybe extensible, as shown at Fig. 7, and may be jointed for the highoperation, as shown at Figs. 36 and 40. The cord is threaded into thecarrying-needle or attened blade, as shown in Figs. 2, 3, 9, and 13.

The operation-The blades, with net attached, are asepticized by boiling.They are then locked at f, g, and I, lubricated, introduced below thepubes, unlocked, circumveluted, preferably individually and one at atime, as shown' in Fig. 27, to the sacrum J, again locked at H, H', andI, and thus secured. The tape is secured, if desired, restricting theouter border D. Traction is then exerted at will on the net. No tractionshould be made on the blades. When the head has reached the perineum,the blades can be taken out, if desired, by simply pulling on them. Theprinciple of force employed is the elasticity which a Woven, knitted, orotherwise elastic fabric possesses when pulled upon, and thuscontracted, as shown by the illustration of the close-fitting knitted orWoven undergarment taken olf by pulling at the cuff. The pressureexerted is so diiused as not to be painful, although sufficient toadhere to the arm, and increases as the pulling increases. To make thesenecessary conditions always present, I have conceived the method ofconstricting the further border of the net above the greater diameter ofthe head, thus surely preventing all slipping. The net passes throughthe slots G G, which hold it rmly by its cord or anchor D, this borderbeing made thick, so that it will not pass through the slit G. Theborder is preferably nonelastic. It does not stretch like the tissue orfabric composing the net. The upper part of the border (that which staysoutside of the slit and goes around the head of the child at IOO IIO

the constriction of the net) may be fiat. It also should be non-elastic.Indeed, the for- Ward edge of the net itself may When stretched untilsufficiently non-elastic be used as the non-elastic part When employedWith a cord or anchor on either side; but as one important feature of mydevice is that this net should not be capable of removal Without theremoval of the instrument or blades the cords used should then have aninward curve, making a cul-de-sac or pocket, as shown in Fig. 16, toreceive the shoulder r of the border of the slot. The borders or cord Don the other side of the slot may be made thick, round, square, or anyshape, providing they run easily through the longitudinal eye F and arethick enough not to go through the slots G. By this arrangement it isseen that the operator has perfect control over the easy application ofthe net, its size, its adherence, its union, the direction of tractionnecessary in any given case, and over the extraction of the instrument,(either the applicating-blades B B' alone or both applicator and net.)It will be clearly seen that the traction is made only on the softevenly-contracting fabric of the net C. It will be seen that by pullingon the inelastic nen-resilient non-tensile border D of the net from theoutside World perfect control is obtained over the most internal partsof the net through the shoulders r r of the slot G and the openings k ofthe longitudinal eye F above the greater' convexity of the head. It willalso be seen that it is not necessary to pull directly on thenon-elastic border of the net to obtain the constriction necessary,Simply holding the net steady and pushing on the applicating-blades aresufficient to accomplish the same result.

lt is apparent that by having the thickened border D continued down thenet as this border emerges in the outside World at the end of the slotthe net can be made to suit any size of head from the size of a childsfist to the size of an adult head. lt will be further seen that theapplicating-blades can be removed at Will, as by pulling on them theyslip off the net C and are extracted, nothing holding them. They holdthe net, but the net does not hold them.

It is observed that when the applicatingblades are removed then only thenet can be removed, not before. Thus Without the blades, if the net isnot removed, delivery can be helped or not, as the attendant may deembest to help or retard it. On account of the head being at the perineumhe may Want to prevent it from coming too fast, so that no tear Willoccur at the outlet.

It Will be seen that the simple and cheap construction of the net-apiece of cloth with a thickened border-makes it possible to use it inbut one case, and then discard it. It is prepared antiseptically as Wedo our antiseptic ganzes in surgery-in fact, resembles the latter verymuch.

It will be readily apparent as a most important factor that by pullingon the net with any force in any case such traction will not increasethe constriction of the upper border of the net as it passes above thegreater conveXity of the head of the child. To accomplish thisconstriction, two methods only can be employed, and they are to push onthe applicating-blades, holding the non-elastic border of the netsteady, or to hold the applicating-blades steady and pull on thenon-elastic border of the net. The pulling of the net alone does notincrease or diminish that constriction any more than in the Wholenet,Which of course contracts some, but evenly in all directions, a factWhich makes this method of delivery most acceptable, as by diusing atthe point of attachment to the child the great force Which is so oftennecessary in the delivery of the child from its mother the dangers offatal injury are lessened to their minimum, and still We have a strongcable attached to the head.

It is apparent that many forms of net, as Well as many forms ofapplicators, can be devised; but the important elements of my device arethe strong elastic fabric or net for inclosing the head and diffusingthe applied force, applicators for applying the same, a running orshifting anchorage on the blades or applicators for the sides of thefabric, a constricting cord, tape, or border operating through eyes 0rover shoulders, and a slot through which the fabric may run as theattached cord is spread over the shoulders of the slots or eyes. I

It is possible that an imperfect result may be obtained by the use ofthe cord-carriers and cord alone, and the instrument may be so made; butan entirely beneficial result cannot thus be'obtained. It will be seenthat the applicating-blades should preferably conform in shape to themothers parts as Well as to the childs head, and that the slot may beplaced longitudinally in any part of the applicating-blades-at its top,bottom, or sides.

The eyes may be transverse rather than longitudinal, as shown at K ofFig. 4. ItWill be further observed that the net offers no obstruction toits own introduction, nor to that of the applicating-blade, for it isconcealed Within the applicating blades in a cavity therein, or it maybe spread smoothly on the concave surface of the blades and moistenedbefore its introduction by a process of sterilization.

It will be seen that the application of my device is made easy, as thenet and cord slide guarded and protected in a slot G and groove F, whichalso guard the mothers parts from their contact, and as the blades aremuch smaller than those of the obstetrical forceps which are applied tothe same parts for the same purpose. Again, in the maternal chamber thevlong diameter is from side to side and the short diameter from front torear. The obstetrical-forceps in its action molds or crushes the infantshead the reverse Wayfrom IOO IIO

this natural dimension, making its long diameter from front to rear andits short diameter from side to side, while my device molds the head andparts in the natural dimension. It will also be seen that the distantflat nonelastic border of the net upon traction at the near end has notthe effect to crush the head of the child at all, but only to hold thehead, slipping slightly to the point of too-great diameter for it toslip any more.

It will be observed that the applicatingblades come with the head aswell as with the net, and that the relative position of the net andblades is not changed at the point of constriction by simple traction onthe net alone.

It will be seen, as shown at Fig. 2S, that the stretched net when pulledupon for eX- traction of the head forms a conical-shaped protrusion,having its base at the circular border of the presenting head and itsapex at the hand of the operator, forming thus a soft wedge-like shape,helping in dilating and preparing the maternal parts for the passage ofthe coming head of the child without possible danger of injury.

It is apparent that the shafts can be made flexible to assist in theapplication of the net, especially for the high operation. They may evenbe made jointed, as illustrated in Figs. 36 and 40, so that theoperating extremity of the instrument may be placed at any angle desiredfor the proper application of the net around the head of the child. Ofcourse they should not be flexible edgewise, for in that direction theapplicator should be rigid.

It can easily be seen that the locks to lock the instrument for entranceand again after application for exit can be placed in a variety ofpositionsfor example, at theinternal edge of each operating extremity ofthe applicator when the two blades are brought together after thecircumvolution of the head of the child of course they must be free fromall sharp or abrupt surfaces. They may also be placed in the concavitypresent on the under surface of the instrumentat the point of unionbetween the operating extremities and the shaft of the instrument. Itmay be made a common clamp holding the rigid blades together, and thuslocking them securely, orit may be any sort of a lock that will effectthe purpose of securing the blades. The clamp shown at Fig. 10 is anadditional lock which may be used after the second position has beenattained.

It will be seen that the perfect continuity of the surface of the netcannot take olf or tear oif the childs ears or nose or disigure him forlife, as do the forceps by their fenester or any instrument which wouldnot have a continuous surface.

It is apparent that the thick border of the net may be made in differentways. For instance, it can be made thicker in two parallel borders, themetal forming the slot passing between the two, as shown in Fig. 17.

It is obvious that by having the cavity between each blade contain eachhalf of the net and each half of the tape or thickened border theapplication (the spreading of the net over the childs head) offers nofriction, no resistance, as the net and border unfold themselves fromthe cavities in which they are placed without resistance and as rapidlyas the case requiresthat is, as rapidly as the blades are circumvolutedaround the head of the child. My device, however, may be used withoutthe pockets for the net, the net being free; but I prefer its carriageinpockets or in the concave of the blades. It may be left entirely freeoutside the blades.

My device can also be operated without the use of the longitudinal eye Fby carrying the cloth in a similarly-slotted applicator, the slot havingshoulders by which the cord or thickened edge of the cloth may bepressed inward and controlled, as shown from F to G in Fig. 33, whichslot may be extended down the instrument.

It will be seen that in applying the net at the symphysis pubis with theapplicatingblades it is not necessary to circumvolute deeply with theblades of the instrument all inserted far as they will go. All that isnecessary is to introduce the net with the aid of the blade for adistance sufficient so that the net will be placed and left over a partof the convexity of the childs head, where it will not slip off, andthen by continuing the circumvolution, not deeply, all around the headuntil the sacrum is reached. Then they must be introduced deeply, ashereinbefore directed. (In this locality there is always considerablespace.) Then, the blades being situated deeply and the point ofresistance (exit and resistance of the net) being at their extreme end,by pulling on the ynon-elastic border of the net the upper part of thenet, which was not deeply applied at first, will thus be brought down inposition over the head of the child in its proper place, just as well asif the head had been circumvoluted deeply the whole length of theblades.

It will be seen that the net can be given a variety of shapes, as shownin Figs. 15 to 25, inclusive, Figs. 19, 2l, 23, and 25 showing the forms18, 20, 22, and 24 when folded together.

It is obvious that the border of the net can be lined with a tape c,besides containing a round cord D, producing the thickening, the smoothsurface of the tape allowing the net more surely to slide easily in theslot and render the border stronger, as shown in Figs. 9 and 14. It canalso be placed between the two cords or thickened border, as illustratedpreviously. It will also be seen that the blades, being at the perineum,which is sometimes expanded to paper-like thinness, affords a means toprotect that part to prevent its tearing, for heilig much smaller thanthe blades of the forceps they take but very IOO IIO

little room and can be made to offer a firm resistance to the advancinghead. They have the proper fiat surface and curve to rotate the headupward instead of downward toward the perineum, as nature often doeswith injurious consequences. It does away with that bagging conditionwhich takes place at the perineum and is so often the cause of the mostsevere tears.

It will be seen that the sliding of the net through either of the slotsis at the command of the operator, for by pressing on one blade duringcircumvolution the net can be made to slide in that blade alone at thewill of the operator by holding the non-elastic border of the net whereit emerges from the other blade.

It is apparent that the net or fabric used may be of any material thathas the necessary pliability or elasticity. It is also obvious that thecord D has two functions-namely, that of serving as an anchorage for thesliding fabric C to prevent it from passing through the slots G and alsothat of constricting the forward border of the fabric or net. When theforward or constricted portion is a tape or the stretched margin of thenet itself, it is constricted in the same way as when the cord iscarried entirely around the head.

While any suitable cloth forms may be used, I prefer that shown in Figs.24, 249, and 25, to form which a V-shaped portion may be cut from aform, as in Fig. 24A, and the notch closed, making a slightly-baggingsomewhat dome-shaped net, as is shown in Fig. 24:, and when foldedtogether, as shown at Fig. 25. In this form the cord in the twoapproaching forward edges is found to run smoothly as the application ismade, and the form is adapted to t the head.

What I claim as new, and desire to secure by Letters Patent, is-

1. In an obstetrical tractor, a form of elastic cloth provided with arunning side anchorage to inserting-blades,substantially as described.

2. In an obstetrical tractor, aform of cloth having a marginalthickening, said marginal thickening being movable and being guardedwhile moving by an enveloping sheath, substantially as described andshown.

3. In an obstetrical tractor, a tractor form of elastic material adaptedto be contracted by longitudinal stretching of the form and thus toconfer a diffused pressure upon the head, and means to apply the form tothe head, substantially as described.

4. In an obstetrical tractor a slotted blade, having front and rearwalls, the front walls of said slot being free and the slot open, andthe rear walls of said slot being partially connected, substantially asdescribed and shown.

5. An obstetrical tractor comprising a form of cloth, and a blade with apocket in the blade to receive the cloth, substantially as described.

6. An obstetrical tractor having a form of cloth, a pair ofapplicating-blades with cavities to receive and guard the cloth andlateral anchorage of the cloth upon the blades, su bstantially asdescribed.

7. In an obstetrical tractor, a carryingblade provided with alongitudinal eye for carrying the edge of a thick-edged fabric; and witha slot opening into the longitudinal eye to allow the fabric to run withthe edge, substantially as described and shown.

8. An obstetrical tractor comprising a pair of blades carrying a formof. elastic fabric, substantially as described and shown.

9. In an obstetrical tractor, a pair of applieating-blades adapted to belocked together in a first and second position, a pliable fabricattached to and adapted to be carried by the blades and circumvolutedabout the head of the infant, and locks for the iirst and secondpositions.

l0. In an obstetrical tractor a pair of independently-operativeapplicating-blades having a slot adapted to receive a form of pliablefabric and hold it in an extended position, substantially as described.

11. In an obstetrical tractor having springing blades B B', a lockcomposed of a lobe and socket, and means to prevent longitudinalmovement of the locked blades, substantially as described and shown.

12. In an obstetrical tractor having blades B B', a lock composed of alobe and socket, and means to prevent longitudinal movement of thelocked blades, substantially as described and shown.

In testimony whereof I affix my signature in presence of two witnesses.

EMILIEN D. ST. CYR.

Witnesses:

ALBERT F. OHLERICH, FREDERICK H. CAsHAw.

